Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 003337 | MN |
N | 111NX0100X | Occupational Health | 003337 | MN |
NPI | 1467584201 |
---|---|
Provider Name | Dr. Chad C Henriksen |
First Address | Waconia, MN 55387-9437 |
Second Address | Waconia, MN 55387-6000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
050M6HE | BLUE CROSS BLUE SHIELD MN (01) | MN |
4489668 | (05) | MN |
U60228 | (02) | MN |